Scholarship Fund Application

Once we receive your application, we will contact you to set up an meeting with you and your child. Scholarships are granted based on financial need.

STUDENTS NAME

First Name

Last Name

BIRTHDATE

YYYY

School Attending and Grade

Parents Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

HOME PHONE

(###)

###

####

CELL PHONE

(###)

###

####

Email Address

If parents are separated or Divorced who has custody of the child?

What is your current estimated annual family income? (no commas please)

How would your child benefit from participating in a formal art program?

How does your child currently involve him/herself in art and what has he/she been involved with in the past?

Does your child take paid extra curricular classes, please list.

I declare that all statements made in this form are true to the best of my knowledge. PLEASE SIGN

I will allow Dragonfly Art Studio to photograph my child for promotional purposes. No names will be used.